A big step towards meeting our objectives

The Chair of NHS England’s Adult Secure Clinical Reference Group reflects on the value of public consultation on the future of adult secure mental health services:

We have spent a lot of time over the past few months listening to ideas about how we can improve adult secure services.

So I’m genuinely pleased that we have now launched a public consultation on the draft specifications for adult medium and low secure mental health service.

This is a key consultation for these services, which form part of the specialised mental health services commissioned by NHS England since April 2013.

We are aiming to reduce unnecessary variation across the country by redesigning the care pathway and ensuring that adult secure services work as part of this pathway, supported by the work of the Quality Network for Forensic Services (Royal College of Psychiatrists).

Within the review team, we set ourselves the following objectives:

  • to provide the right services in the right location, so patients can access them at the right time
  • to ensure equity of access, regardless of where patients live
  • to develop a whole pathway approach
  • to reduce unwarranted variation in the services commissioned and provided, in terms of the specification, quality and price.

The consultation is about the specifications for adult medium and low secure mental health services for men and women who have a mental illness, personality disorder, neurodevelopmental disorder, learning disability or autistic spectrum disorder.

This covers a large and complex range of services –  with over 6,500 inpatient beds – providing care and treatment for individuals with mental and/or neurodevelopment disorders who are liable to be detained under the Mental Health Act (1983),  and whose risk of harm to others and risk of escape from hospital cannot be managed safely within other mental health settings.

People using these services will typically have complex mental disorders, associated with offending or seriously harmful behaviour. Some will be involved with the criminal justice system, courts and prison, and may have Ministry of Justice restrictions imposed.

To get to this critical stage has involved many months of discussion with people who have used secure services, clinicians, managers, commissioners, carers, and various government departments including the Ministry of Justice,  Department of Health, National Offender Management Service and members of the public.

We have looked in detail at the current specifications and thought about how to improve outcomes and make even better connections across the secure care pathway.

This consultation is a significant step towards meeting our objectives – and due in no small part to the hard work by specialist mental health leads across England, various NHS networks and Rethink who – using the Recovery and Outcomes network – are supporting events up and down the country with patients and staff working in secure services.

Rethink are facilitating events for carers and families – listening to ideas about what would make these services the best they can be.  All ideas are welcome via #AdultSecure. #MentalHealth.

Next Tuesday,  14 March 2017, we are holding a national face to face event for clinicians, providers, local CCGs, local authority commissioners, Ministry of Justice, National Offender Management Service and Department of Health.  Members of the Adult Secure Clinical Reference Group will be there to answer questions and discuss various elements of the specifications. If you work for any of the organisations listed above and you wish to join us at this event, please register by emailing:

Working alongside this consultation, the new care model programme will give mental health trusts the incentives and responsibility to greatly improve local services and end the practice of sending people long distances to receive treatment, unless this is clinically necessary.

Across the four Adult Secure sites in South London, the South West, Thames Valley and Wessex and the West Midlands, they will take responsibility for the commissioning budget and deliver higher quality of care for thousands of patients, including moving patients closer to home.

By reducing admissions, out of area placements and lengths of stay, the four sites predict savings of over £40million, which will be reinvested in better local services, including crisis teams, triage teams, supported housing and beds

As these services are specialist in nature it is important that there is national oversight, but with a strong emphasis on local engagement and ownership.  I have particularly appreciated working with NHS England Health and Justice (H&J) and National Offender Management (NOMS), Offender Personality Disorder Programme (OPD) colleagues to offer opportunities to consult with people currently in prison, who may have accessed these services in the past, or need to access them in the future.

In launching this consultation we are opening a national conversation on adult secure services. Please join in at #AdultSecure #MentalHealth.

David Fearnley

Dr David Fearnley was appointed Consultant Forensic Psychiatrist in 2001, at Ashworth Hospital, one of three high security hospitals in England.

He was appointed Medical Director for Mersey Care NHS Trust in 2005, where he was also seconded as Medical Director for Calderstones Partnership NHS Foundation Trust (May 2015-July 2016).

A former Psychiatrist of the Year (2009) by the Inaugural Royal College of Psychiatrists, David also received the Healthcare Financial Management Association (in association with the Academy of Royal Colleges) ‘Working with Finance – Clinician of the Year’ award (2013).

He was named in HSJs “100 Clinical Leaders List” (2015) as Mersey Care Trust’s driving force behind an international partnership with The Risk Authority, Stanford, and Lockton insurance brokers to manage and predict risk in mental health.

In 2016, David was appointed Associate National Clinical Director for Secure Mental Health and Chair of the Adult Secure Clinical Reference Group, NHS England.